Abstract:

We apply parametric and nonparametric regression discontinuity methodology
within a multinomial choice setting to examine the impact of public health care
user fee abolition on health facility choice using data from South Africa. The
nonparametric model is found to outperform the parametric model both in- and
out-of-sample, while also delivering more plausible estimates of the impact of user
fee abolition (i.e., the `treatment e ect'). In the parametric framework, treatment
e ects were relatively constant { around 10% { and that increase was drawn equally
from home care and private care. On the other hand, in the nonparametric framework
treatment e ects were largest for large (and poor) families located farther from
health facilities { approximately 5%. More plausibly, the positive treatment e ect
was drawn primarily from home care, suggesting that the policy favoured children
living in poorer conditions, as those children received at least some minimum level
of professional health care after the policy was implemented.